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BSc Medical Imaging > X ray > Flashcards

X ray Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the attenuation

A

absorption of Xray based on density

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2
Q

What does black mean in Xray

A

Air/Gas

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3
Q

What does dark grey mean in Xray

A

fat

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4
Q

What does light grey mean in Xray

A

soft tissues and fluid

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5
Q

What does white mean in Xray

A

bone and calcification

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6
Q

What does bright white mean in Xray

A

Metal

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7
Q

Why might the edges of tissue be sharp

A

Movement
Imaging equipment
structure does not have a sharp edge

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8
Q

What is the most commonly requested diagnostic xray

A

chest

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9
Q

First step to interpreting an xray

A

Correct patient,

Projection of image (PA/AP)

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10
Q

What happens to the scapula in PA and AP fields

A

PA

  • scapula retracted
  • clear view of lung fields

AP

  • medial border of scapula can be seen
  • obscures part of the lung field
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11
Q

How do you assess the technical quality of a chest xray

A

Field

  • entire thorax
  • apices and first ribs to costophrenic angles
  • humeral heads included

Rotation
-medial ends of the clavicles should be equidistant from spinous processes

Inspiration

  • Deep inspiration
  • Should be at least 8-10 posterior ribs
  • 5-7 anterior ribs
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12
Q

How do you assess the penetration of the image

A

outlines of vertebral bodies should be just visible behind the heart

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13
Q

Which lung has a middle lobe

A

Right

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14
Q

What are some terms used to describe obvious abnormalities

A

Focal/diffuse

Rounded/spiculated

Well/Poorly demarcated

Single/Multiple lesion

Remember to describe other features such as lines, tubes clips, fluid levels

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15
Q

What is the systemetic review step for CXR

A

Airway
-Trachea deviated?
(tension pneumothorax = away, lung collapse = towards)

Breathing

  • full expanded chest
  • fissures

Cardiac

  • Central mediastinum (positioned over thoracic vertebrae)
  • Cardiothoracic ratio
  • Clear borders

Diaphragm

  • both visible and convex
  • free air
  • costophrenic angles
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16
Q

Why is the right hemidiaphragm usually higher

A

Liver

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17
Q

List some commonly missed areas of the lung of CXR

A 
Apices
Costophrenics
Behind heart
Underneath diagphragm
Soft tissues
Bones -  lytic lesions
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18
Q

What is the whole process of assessing CXR

A 
Patient details
Projection
Technical quality
Obvious abnormalities
Systematic review
19
Q

What shows up as air under the left lung

A

Gastric bubble

Pneumoperitoneum

20
Q

What is characteristic of the small intestine

A

Plicae circulares - full width of the lumen

21
Q

What is characteristic of the large intestine

A

Haustra - partial width of lumen

22
Q

Are gallstones radio-opaque

A

Not really

- approx 10% are radio-opaque

23
Q

Are kidney stones radio-opaque

A

60%

24
Q

Where are the kidneys on AXR

A

lateral to psoas major
t12-L3
Right lower than left due to liver

Adrenal glands not usually visible unless calcified

25
Q

What are the structures visible on AXR

A

Stomach

Intestines

Kidneys

Liver

Spleen

Psoas major

Pancreas - not visible
unless calcification

Bladder

Aorta - if calcified
(>3cm diameter - possible aneurysm)

Bones

26
Q

What are the CXR features of pulmonary fibrosis

A 
decreased lung volume due to scarring 
Mediastinal shift due to volume loss
Ground glass appearance
Honeycombing - advanced
Blurring between mediastinum and diaphragm
27
Q

What are the signs of pulmonary oedema on CXR

A

Alveolar shadowing - oedema in the alveoli
Kerly B lines 0 oedema of interlobular septa
Cardiomegaly
Dilated pulmonary vessels
Pleural effusions

28
Q

How do you differentiate between small and large bowel

A

Small bowel
-plicae circulares - cross entire diameter of bowel

Large bowel
-haustra - cross part of the diamter

NB
-longitudinal taenia coli muscles

29
Q

What is the coffee bean sign

A

Sign of volvulus in left iliac fossa

30
Q

What are the most common causes of bowel obstruction

A

Small bowel
- Adhesions

Long bowel
-tumour or stirctures

31
Q

What are some signs of volvulus

A

Grossly distended inverted loop
RUQ pointing - sigmoid, LUQ pointing - caecal
Loss of haustral folds

32
Q

Which calculi are radiopaque

A

Urinary calculi
- 80% - contain calcium - radiopaque

Biliary calculi

  • Cholesterol
  • Radiolucent –> USS more sensitive
33
Q

What are the AXR indications

A

Perforation
Megacolon
Obstruction
Foreign bodies

34
Q

What is expressed in the caudal embryo

A

brachyury

35
Q

What does a double cardiac shadow mean

A

Lobe collapse

36
Q

What spinal levels do the ligaments run between

A

Ant long

  • occipital bone to sacrum
  • resists hyperextension

Post long

  • C2 to sacrum
  • prevents posterior herniation of IV disc

Ligamentum flavum
-binds lamina

Intertransverse
-binds transverse processes

37
Q

How do elbow dislocations occur

A

50% sports injury

Elbow one of the most stable joints

Distal humerus displaced form trochlear notch of elecranon

Humerus gets driven through weaker anterior capsule

38
Q

What indicates a cavitating mass on CXR

A

Fluid level

39
Q

What does an air bronchogram signify

A

Tram tracks

- consolidation around an airway

40
Q

What are the signs of bronchiectasis on XR

A

Thickened bronchial walls
Ring shadows (thickened airways seen end-on)
Volume loss secondary to mucous plugging
Air-fluid levels may be visible within dilated bronchi

41
Q

When can ascites be detected on AXR

A

> 500ml

42
Q

What are the radiographic features of ascites on AXR

A

Diffusely increased density of the abdo

Poor definition of the soft tissue shadows e.g. psoas mucsle, liver, spleen

Medial dispalcement of viscera and bowel

Bulging of the flanks

Increased separation of small bowel loops

43
Q

How do you distinguish between right upper, middle and lower lobe consolidation

A

lower - diaphragmatic border isn’t visible

middle - heart border isn’t distinguishable

upper - diaphragmatic and heart border will be visible

BSc Medical Imaging (5 decks)

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